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目的观察阿托伐他汀对糖尿病心肌病患者心脏舒张功能的影响并探讨其可能机制。方法选取2013年5月至2014年1月期间在北京友谊医院诊断为早期糖尿病心肌病的70例患者作为研究对象,随机分为辛伐他汀组36例,阿托伐他汀组34例,测定糖基化终末产物(AGEs)、血脂和糖化血红蛋白(Hb A1C)水平,用超声心动仪测定左室射血分数(LVEF)和舒张早期峰值速度/舒张晚期峰值速度(E/A)比值,并进行纽约心脏病协会(NYHA)分级。用SPSS 13.0统计软件对数据进行t检验和χ~2检验,采用Spearman相关分析法评估E/A比值与AGEs的相关性。结果辛伐他汀组及阿托伐他汀组基线时血脂、HbA1C、AGEs水平、LVEF、E/A比值和NYHA分级差异均无统计学意义(P>0.05)。干预12个月后两组间血脂、HbA1C、AGEs水平和LVEF差异均无统计学意义(P>0.05);阿托伐他汀组NYHAⅡ级(16例,47.1%)和Ⅲ级人数(2例,5.9%)明显少于辛伐他汀组[分别为25例(69.4%)、5例(13.9%)],差异有统计学意义(P<0.05),且E/A比值(1.19±0.14)低于辛伐他汀组(1.27±0.10),差异有统计学意义(P<0.05)。基线AGEs水平与EA比值呈正相关(R2=0.35,P<0.01)。结论阿托伐他汀能够改善2型糖尿病心肌病患者的心脏舒张功能不全。
Objective To investigate the effect of atorvastatin on cardiac diastolic function in patients with diabetic cardiomyopathy and to explore its possible mechanism. Methods Seventy patients diagnosed with early diabetic cardiomyopathy at Beijing Friendship Hospital from May 2013 to January 2014 were selected and randomly divided into simvastatin group (36 cases) and atorvastatin group (34 cases) (AGEs), serum lipid and Hb A1C levels were measured. Left ventricular ejection fraction (LVEF) and early / early diastolic peak velocity (E / A) ratio were measured by echocardiography. New York Heart Association (NYHA) grading. SPSS 13.0 software was used to test the data t-test and χ ~ 2 test, Spearman correlation analysis was used to assess the E / A ratio and AGEs correlation. Results There were no significant differences in serum lipids, HbA1C, AGEs levels, LVEF, E / A ratio and NYHA classification between simvastatin group and atorvastatin group at baseline (P> 0.05). There was no significant difference in the levels of blood lipids, HbA1C, AGEs and LVEF between the two groups after intervention for 12 months (P> 0.05). The NYHA class Ⅱ (16 cases, 47.1%) and the class Ⅲ (2 cases) 5.9%) were significantly less than those in simvastatin group [25 (69.4%, 5 vs 13.9%, respectively]] (P 0. 05), and the E / A ratio was 1.19 ± 0.14 In simvastatin group (1.27 ± 0.10), the difference was statistically significant (P <0.05). Baseline AGEs levels were positively correlated with EA ratio (R2 = 0.35, P <0.01). Conclusions Atorvastatin can improve diastolic dysfunction in patients with type 2 diabetic cardiomyopathy.